In the distant past, surgery was performed by a surgeon who would typically open a patient in order to visualize and diagnose the operation and function of internal organs. Visualization through this open procedure might indicate the presence of a tumor, for example. At this point, the surgeon would undertake the indicated therapy, such as removal of the tumor.
More recently, new technologies and automation have greatly increased the diagnostic function of the surgeon. Notably, non-invasive visualization techniques are now available through X-ray fluoroscopy and magnetic imaging which can aid in the location and diagnosis of anatomical problems. With automated procedures, the same diagnosis or therapy can typically be reproduced to offer the safest and most effective procedure regardless of variations in the knowledge and skill of the surgeon.
Notwithstanding this automation of diagnostic procedures, the actual therapy required has continued to rely on the knowledge and skill of the surgeon who is operating increasingly with small mechanical devices such as clips, clamps, scalpels, retractors, and needles, for example. With one exception, the therapeutic procedures have not been particularly automated so they continue to rely heavily on the subjective knowledge and skill of the surgeon.
The one exception, which uses electrosurgical energy to cut, coagulate, or fulgurate tissue, highlights some of the advantages of modern technology. This procedure involves the use of electrosurgical energy to cut, coagulate, or fulgurate tissue. Evolution of this technology has produced sophisticated electrosurgical generators that offer a high degree of control over voltage and frequency. With appropriate variations in these parameters, signals can now be developed which are adapted for a particular purpose, such as cutting or coagulation, as well as a particular patient.
Notwithstanding these advances in the production of electrosurgical signals, the delivery of those signals has remained highly subjective to the knowledge and skill of the surgeon. Thus, the electrosurgical energy must be delivered through a handpiece that is moved over a desired area while a precise distance of separation between the handpiece and the tissue is maintained. In this latter regard, contact between the handpiece and the tissue to be avoided; rather, a slight spacing is beneficial as it promotes the desired sparking associated with the electrosurgical effect. Although much teaching has been devoted to train surgeons in these procedures, there continues to be a wide variation in the knowledge and skill implementing this therapeutic procedure.